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 Table of Contents  
Year : 2020  |  Volume : 22  |  Issue : 3  |  Page : 83-87

COVID-19 Preventive measures among health-care workers: Desperate times, desperate measures

Department of Internal Medicine, AFMC, Pune, Maharashtra, India

Date of Submission25-Jul-2020
Date of Decision22-Aug-2020
Date of Acceptance18-Sep-2020
Date of Web Publication09-Oct-2020

Correspondence Address:
Gp Capt T VSVGK Tilak
Department of Internal Medicine, AFMC, Solapur Road, Pune - 411 040, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmms.jmms_99_20

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Background: In these desperate times when the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic has caught the entire world off guard, we have very few evidence-based preventive measures currently available. Various preventive practices, which include both pharmacological interventions (PIs) and non-PIs (NPI), adopted by the health-care workers (HCWs) might play a crucial role in protecting them against COVID-19. This study aims to identify these preventive measures adopted by HCWs in a dedicated 1000-bedded temporary COVID-19 hospital in northern India, with HCWs coming from various parts of the country. Objectives: The objective was to study the various forms of preventive measures undertaken by HCWs and to calculate their prevalence. Methodology: This cross-sectional web-based survey was conducted in a population of HCWs in a 1000-bedded COVID-19 hospital in northern India. Results: Most HCWs included in the study were using multiple preventive measures not necessarily backed by evidence. In this study, 81.8% of the participants were using hydroxychloroquine (HCQ) prophylaxis. Nurses had the highest adherence to HCQ prophylaxis, however they were also the most concerned regarding side effects. Increase in the frequency of hand hygiene and bathing practices was seen in majority of the participants. HCWs were also found to practice various preventive measures such as Vitamin C supplements (37.8%), yoga (37.1%), and warm saline gargles (36.3%). Other less common methods noted were steam inhalation, amlaki, kaadha, tulsi drops, chyawanprash, and nasya. The Internet served as the main source of information. Conclusion: The role of various preventive practices in the setting of a novel infection needs to be studied further. With no dearth in information advocating various proven or unproven strategies available on the Internet, their use by both HCWs and general population is inevitable. This is irrespective of their job or educational profiles. Whether or not such practices are useful in our fight against COVID-19 is a question that can only be answered through further studies.

Keywords: COVID-19, health-care workers, nonpharmacological interventions, pharmacological interventions, prophylaxis

How to cite this article:
Mohakuda S, Pathak B, Singh AR, Tilak T V, Harikrishnan P. COVID-19 Preventive measures among health-care workers: Desperate times, desperate measures. J Mar Med Soc 2020;22, Suppl S1:83-7

How to cite this URL:
Mohakuda S, Pathak B, Singh AR, Tilak T V, Harikrishnan P. COVID-19 Preventive measures among health-care workers: Desperate times, desperate measures. J Mar Med Soc [serial online] 2020 [cited 2021 Dec 3];22, Suppl S1:83-7. Available from: https://www.marinemedicalsociety.in/text.asp?2020/22/3/83/297615

  Introduction Top

At the dawn of the 21st century, humankind is faced with one of the most devastating and crippling challenges, the COVID-19 pandemic. The outbreak is believed to have originated from Wuhan, China, in December 2019.[1] Over the following months, the disease has rapidly spread across continents, and was declared a pandemic by the World Health Organization on March 12, 2020.[2] Presently, the disease has spread in over 200 countries and has affected over 11 million people with a death toll of more than half a million.[3]

In India, despite a dawdling start due to lockdowns, the infection has picked up its pace and has shown increase in the number of cases and deaths at an alarming rate.[4] HCWs constitute a high-risk group in contracting the illness, which has adversely impacted the already-burdened health-care facilities.[5] Various preventive measures adopted by HCWs thus play a crucial role in slowing the spread of COVID-19 infection and keep the health-care machinery running.[6] Various strategies against COVID-19 infection, although not supported by evidence, are being practiced by both the general population and HCWs. This study focuses on identifying the prevalence of such practices which include both pharmacological interventions (PIs) and nonpharmacological interventions (NPIs), being practiced by HCWs in a 1000-bedded temporary COVID-19 hospital in northern India.

  Methodology Top

This study reports the results of a cross-sectional web-based survey in a population of HCWs, which included doctors, nurses, and paramedical staff deployed in the management of moderate and severe cases of COVID-19 infection in a temporary 1000-bedded COVID hospital. Selection bias of study participants was eliminated by including HCWs from all tenets of health-care provision. Assuming a 50% prevalence of various preventive practices among HCWs working in COVID hospital (no previous study available), with a precision of 5%, power of 80%, and finite correction for population (n = 250), the estimated sample size was 132. Thus, our study included 132 participants.

A web-based questionnaire was framed based on the current literature and was adapted to the current study. The questionnaire was pretested in twenty HCWs and modified according to the feedback received. Later, the questionnaire was disseminated to all study participants after taking informed consent. The questionnaire included a total of 17 questions, 3 related to sociodemographic parameters and 14 related to various preventive measures adopted by the participants. The preventive measures included various PIs and NPIs, wherein NPIs are defined as, actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses like pandemic influenza (flu).[7] Data were compiled and analyzed using Microsoft Excel and IBM SPSS statistics 20 Version (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Microsoft Excel. 2010), respectively. Mean and standard deviation were calculated for the continuous variables, while proportions were used for the categorical variables. For proportions, 95% confidence interval (CI) was calculated. Chi-square test was used to study association, and P < 0.05 was considered statistically significant.

  Results Top

The study was based in a 1000-bedded dedicated COVID-19 hospital in northern India, which included HCWs involved in various tenets of health-care provision and had come from different parts of the country. A total of 132 HCWs were included in the study and were administered the questionnaire. The age distribution of the study participants ranged from 23 to 47 years (mean ± standard deviation = 30.15 + 4.45 years). Of these, 72% (n = 95; 95% CI, 64–79) were graduates, 13.6% (n = 18; 95% CI, 7–19) were postgraduates, and the remaining were having diplomas or senior secondary level of education. In addition, 48.5% (n = 64; 95% CI, 39–57) of the study participants were doctors, 29.5% (n = 39; 95% CI, 21–37) were nurses, and 21.2% (n = 28; 95% CI, 14–28) were paramedical staff [Table 1].
Table 1: Sociodemographic characteristics of the study participants

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A marked change was noted in the personal hygiene and sanitation practices adopted by the HCWs even while off duty. Nearly 72% (n = 95; 95% CI, 64–79) of the study participants used both alcohol-based sanitizer and hand washing with soap and water as opposed to 25.8% (n = 34; 95% CI, 18–33) who used only hand washing with soap and water [Table 2]. Almost 97.7% (n = 129; 95% CI, 95–100) of the study participants stated that they washed their hands as per existing guidelines.[8] Out of them, 54.5% (n = 72; 95% CI, 46–63) washed their hands every time after contact with possible fomites. Apart from hand hygiene practices, a change in bathing habits was also noted with 68.2% (n = 90; 95% CI, 60–76) of the HCWs, taking a bath every time after returning from patient care areas.
Table 2: Hand sanitization practice within room/home

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The use of hydroxychloroquine (HCQ) prophylaxis was observed in 81.8% (n = 108; 95% CI, 75–88) of the study participants, out of which 82.4% (n = 89; 95% CI, 75–90) [Table 3] used it due to institutional policy, while remaining 17.6% (n = 30; 95% CI, 10–24) were self-motivated (P < 0.0001). Nurses (100%, n = 39) showed maximum adherence to HCQ prophylaxis followed by doctors (81%, n = 52, 95% CI, 72–91), and the adherence was least among paramedical staff (76%, n = 22, 95% CI, 60–91), which was statistically significant (P < 0.001). The fear of adverse effects of HCQ was prevalent in 43.9% (n = 58; 95% CI, 35–52) of the study participants, among which nurses were most concerned (56%) followed by doctors (50%) and the paramedical staff (14%) (P < 0.001). Apart from HCQ, 67.4% (n = 89; 95% CI, 59–75) of the study participants were using various other PIs and NPIs as prevention against COVID-19 infection [Table 4]. The most common among them was the use of Vitamin C supplements which encompassed a cumulative 37.8% (n = 50; 95% CI, 29–46), closely followed by yoga at 37.1% (n = 49; 95% CI, 28–45) and warm saline gargles at 36.3% (n = 48; 95% CI, 28–44). Other common practices included chywanprash, tulsi drops, kaadha, and nasya [Figure 1]. About 45% (n = 60; 95% CI, 37–54) of the study participants used more than one preventive measure.
Table 3: Details of hydroxychloroquine prophylaxis

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Table 4: Pharmacological and nonpharmacological interventions practiced by health-care workers

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Figure 1: Frequencies of various preventive measures against COVID-19 among health-care workers

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The Internet was the leading source of information with 42.4% (n = 56; 95% CI, 33–50) followed by family members and friends with 33.3% (n = 44; 95% CI, 25–41). It was also observed that 82.6% (n = 109; 95% CI, 76–89) of the HCWs deliberately reduced visitors to their rooms and 65.2% (n = 86; 95% CI, 57–73) did not visit their friends or family staying in or around the workplace in view of the ongoing pandemic.

  Discussion Top

The COVID-19 pandemic has affected India gravely.[9] These testing times have instigated our thoughts to adopt various preventive practices as a respite against the pandemic. Our study brings forth the prevalence of these practices, which include both PIs and NPIs, among HCWs in a dedicated 1000-bedded COVID-19 hospital in northern India.

Our study participants had a mean age 30.15 years. It included HCWs of various educational qualifications. Since the outbreak of COVID-19 pandemic, various health agencies have recommended preventive measures for the general population as well as HCWs. Previous studies on hand hygiene practices and adherence to recommendations by HCWs have reported prevalence ranging from 5% to 89% with an average of 38.7%.[10],[11],[12],[13],[14],[15],[16],[17],[18] In our study, we observed that a significant proportion of the study participants have adopted hand hygiene practices in an effort to prevent COVID-19 infection. Nearly 72% (n = 95; 95% CI, 64–79) of the study participants resorted to both alcohol-based sanitizer and hand washing with soap and water as opposed to 25.8% (n = 34; 95% CI, 18–33) who used only hand wash with soap and water. Most of them (97.7%, n = 129; 95% CI, 95–100) stated that they washed their hands as per the existing guidelines.

The role of HCQ in attaining early virological response has been shown in previous studies.[19],[20] Its additional immunosuppressive properties have also been hypothesized to reduce the pro-inflammatory cytokines such as interleukin (IL) IL-1, IL-6, interferon-α, and tumor necrosis factor that are implicated in the causation of cytokine storm which complicates the course of COVID-19 illness.[21],[22] Although the preliminary studies on the efficacy of HCQ against COVID-19 had been promising, many studies that followed have discredited them by citing lack of adequate evidence.[23],[24],[25],[26] HCQ has been incorporated in the Indian Council of Medical Research guidelines for both management and prophylaxis of COVID-19.[27] Our study revealed a high prevalence (81.8%) of HCQ prophylaxis among HCWs, which was primarily because of institutional policies (P < 0.0001). There was a statistically significant difference among different professions, in acceptance of the drug (P < 0.001) with the highest prevalence among nurses followed by doctors and paramedical staff. In a previous study on HCWs' attitude, adherence to regime, and side effects of HCQ, a similar prevalence of around 76% was observed for intake of HCQ prophylaxis.[28] The fear of adverse effects was observed mostly among the nurses and the doctors while the paramedical staffs were least concerned about its side effects. The lower levels of awareness about the possible adverse effects of HCQ among paramedical staff could be a reason behind this statistically significant difference.

The use of various PIs and NPIs to boost immunity has been in practice for long. Vitamin C has an established role in both innate and adaptive immunity through modulation of cellular functions, which also aid in reducing the susceptibility to various viral infections.[29],[30] This cost-effective drug has also been proposed as a prophylactic agent against SARS-CoV2 infection by some authors.[31] As noted in our study, 67.4% (n = 89; 95% CI, 59–75) of the HCWs resorted to some preventive measure other than HCQ prophylaxis and sanitation practices. Among them, Vitamin C supplements were used by most (37.8%) closely followed by yoga and warm saline gargles. The Internet was the leading source of information with 42.4% (n = 56; 95% CI, 33–50) followed by family members and friends at 33.3% (n = 44; 95% CI, 25–41). No previous studies on the prevalence of use of such preventive measures by HCWs could be identified after extensive literature search. However, few studies have highlighted their possible role in the prevention of COVID-19.[32],[33],[34],[35] Apart from these, a change in general attitude toward physical distancing and reducing the number of contacts has also been observed.

  Conclusion Top

The SARS-CoV-2 pandemic has impacted the world with alarming intensity bringing day-to-day life to standstill. Our study which aimed to identify the prevalence of various preventive practices among HCWs, while revealing significant changes in personal hygiene and sanitation practices, also identified the use of various PIs and NPIs as possible immunity boosters against COVID-19. The Internet was the leading source from which the above information was gathered by the HCWs. The possibility of these practices as potential prophylaxis against COVID-19 infection is not yet proven. As we make advances in our fight against this pandemic, the results of this study may later be extrapolated in assessing the efficacy of these preventive measures to tackle COVID-19 infection or any similar pandemic in future.

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Conflicts of interest

There are no conflicts of interest.

  References Top

WHO | Novel Coronavirus – Japan (ex-China). Available from: https://www.who.int/csr/don/17-january-2020-novel-coronavirus-japan-ex-china/en/. [Last accessed on 2020 Jul 06].  Back to cited text no. 1
WHO/Europe | Coronavirus Disease (COVID-19) Outbreak-WHO Announces COVID-19 Outbreak a Pandemic. Available from: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic. [Last accessed on 2020 Jul 06].  Back to cited text no. 2
Coronavirus Cases: Worldometer; 2020. Available from: https://www.worldometers.info/coronavirus/. [Last accessed on 2020 Jul 06].  Back to cited text no. 3
#IndiaFightsCorona COVID-19 in India, Corona Virus Tracker | mygov.in. Available from: https://www.mygov.in/covid-19. [Last accessed on 2020 Jul 06].  Back to cited text no. 4
Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo CG, Ma W et al. Risk of COVID-19 among front-line health-care workers and the general community: A prospective cohort study. Lancet Public Health. 2020;5:e475-e483. Published 2020 Jul 31. doi:10.1016/S2468-2667(20)30164-X.  Back to cited text no. 5
Protective Measures Covid19. Available from: https://www.who.int/southeastasia/outbreaks-and-emergencies/novel-coronavirus-2019/protective-measures. [Lastaccessed on 2020 Jul 07].  Back to cited text no. 6
Nonpharmaceutical Interventions (NPIs) | CDC. Available from: https://www.cdc.gov/nonpharmaceutical-interventions/index. Html. [Last accessed on 2020 Sep 05].  Back to cited text no. 7
World Health Organization. WHO Save Lives: Clean Your Hands in the Context of Covid-19. Geneva, Switzerland: World Health Organization; 2020. Available from: https://www.who.int/infection-prevention/campaigns/clean-hands/WHO_HH-Community-Campaign_finalv3.pdf?ua=1. [Last accessed 2020 Jul 20].  Back to cited text no. 8
MoHFW | Home. Available from: https://www.mohfw.gov.in. [Last accessed on 2020 Jul 21].  Back to cited text no. 9
WHO Guidelines on Hand Hygiene in Health Care:First Global Patient Safety Challenge Clean Care Is Safer Care. (2009). World Health Organization.  Back to cited text no. 10
Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307-12. Available from: https://pubmed.ncbi.nlm.nih.gov/11073019/. [Last accessed on 2020 Jul 21].  Back to cited text no. 11
Goyal A, Narula H, Gupta PK, Sharma A, Bhadoria AS, Gupta P. Evaluation of existing knowledge, attitude, perception and compliance of hand hygiene among health care workers in a Tertiary care centre in Uttarakhand. J Family Med Prim Care 2020;9:1620-7.  Back to cited text no. 12
  [Full text]  
Bharara T, Gur R, Duggal S, Chugh V. Evaluation of hand hygiene compliance over the years, in an intensive care unit of a north Delhi hospital preparing for accreditation: A 3-year study. J Family Med Prim Care 2020;9:1939-43.  Back to cited text no. 13
  [Full text]  
Pittet D. Compliance with hand disinfection and its impact on hospital-acquired infections. J Hosp Infect 2001;48 Suppl A: S40-6.  Back to cited text no. 14
Longembe EB, Kitronza PL. Compliance with hand-hygiene practice in the General Reference Hospitals of the city of Kisangani, Democratic Republic of the Congo. Pan Afr Med J 2020;35:57.  Back to cited text no. 15
Simon AC. Hand hygiene, the crusade of the infection control specialist. Alcohol-based handrub: The solution! Acta Clin Belg 2004;59:189-93.  Back to cited text no. 16
Dubbert PM, Dolce J, Richter W, Miller M, Chapman SW. Increasing ICU staff handwashing: Effects of education and group feedback. Infect Control Hosp Epidemiol 1990;11:191-3.  Back to cited text no. 17
Mayer JA, Dubbert PM, Miller M, Burkett PA, Chapman SW. Increasing handwashing in an intensive care unit. Infect Control 1986;7:259-62. Available from: https://pubmed.ncbi.nlm.nih.gov/3635490/. [Last accessed on 2020 Jul 21].  Back to cited text no. 18
Helal GK, Gad MA, Abd-Ellah MF, Eid MS. Hydroxychloroquine augments early virological response to pegylated interferon plus ribavirin in genotype-4 chronic hepatitis C patients. Med Virol 2016;88:2170-8. Available from: https://pubmed.ncbi.nlm.nih.gov/27183377/. [Last accessed on 2020 Aug 25].  Back to cited text no. 19
Sperber K, Chiang G, Chen H, Ross W, Chusid E, Gonchar M, et al. Comparison of hydroxychloroquine with zidovudine in asymptomatic patients infected with human immunodeficiency virus type 1. Clin Ther 1997;19:913-23. Available from: https://pubmed.ncbi.nlm.nih.gov/9385480/. [Last accessed on 2020 Aug 25].  Back to cited text no. 20
Schrezenmeier E, Dörner T. Mechanisms of action of hydroxychloroquine and chloroquine: Implications for rheumatology. Nat Rev Rheumatol 2020;16:155-66. Available from: https://pubmed.ncbi.nlm.nih.gov/32034323/. [Last accessed on 2020 Aug 25].  Back to cited text no. 21
Zhao M. Cytokine storm and immunomodulatory therapy in COVID-19: Role of chloroquine and anti-IL-6 monoclonal antibodies. Int J Antimicrob Agents 2020;55:105982.  Back to cited text no. 22
Nina P, Dash A. Hydroxychloroquine as prophylaxis or treatment for COVID-19: What does the evidence say? Indian J Public Health 2020;64:125. Available from: http://www.ijph.in/text.asp?2020/64/6/125/285615. [Last accessed on 2020 Aug 24].  Back to cited text no. 23
Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Sevestre J, et al. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study. Travel Medicine and Infectious Disease 2020;34:101663. https://doi.org/10.1016/j.tmaid.2020.101663.  Back to cited text no. 24
Ferner RE, Aronson JK. Chloroquine and hydroxychloroquine in covid-19. BMJ (Clinical research ed.), 2020;369:m1432. https://doi.org/10.1136/bmj.m1432.  Back to cited text no. 25
Taccone FS, Gorham J, Vincent JL. Hydroxychloroquine in the Management of Critically ill Patients with COVID-19: The Need for An Evidence Base; 2020. Available from: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/. [Last accessed on 2020 Aug 25].  Back to cited text no. 26
Bhattacharyya D, Raizada N, Nagappa B, Tomar A, Maurya P, Chaudhary A, et al. Chemoprophylaxis of COVID-19 with hydroxychloroquine: A study of health care workers attitude, adherence to regime and side effects. Available from: https://doi.org/10.1101/2020.06.11.20126359. [Last accessed on 2020 Jul 22].  Back to cited text no. 28
Ang A, Pullar JM, Currie MJ, Vissers MCM. Vitamin C and immune cell function in inflammation and cancer. Biochem Soc Trans 2018;46:1147-59. Available from: https://doi.org/10.1042/BST20180169. [Last accessed on 2020 Aug 25].  Back to cited text no. 29
Carr AC, Maggini S. Vitamin C and Immune Function. Nutrients. 2017 Nov 3;9(11):1211. doi: 10.3390/nu9111211. PMID: 29099763; PMCID: PMC5707683.  Back to cited text no. 30
Feyaerts AF, Luyten W. Vitamin C as prophylaxis and adjunctive medical treatment for COVID-19? Nutrition. 2020 November-December;79:110948. doi: 10.1016/j.nut.2020.110948. Epub 2020 Jul 25. PMCID: PMC7381407.  Back to cited text no. 31
Zhang L, Yu J, Zhou Y, Shen M, Sun L. Becoming a Faithful Defender: Traditional Chinese Medicine against Coronavirus Disease 2019 (COVID-19). Am J Chin Med 2020;48:763-77.  Back to cited text no. 32
Zhang YS, Cong WH, Zhang JJ, Guo FF, Li HM. Research progress of intervention of chinese herbal medicine and its active components on human coronavirus. Zhongguo Zhong Yao Za Zhi 2020;45:1263-71.  Back to cited text no. 33
Du HZ, Hou XY, Miao YH, Huang BS, Liu DH. Traditional Chinese medicine: An effective treatment for 2019 novel coronavirus pneumonia (NCP). Chin J Nat Med 2020;18:206-10. Available from: https://pubmed.ncbi.nlm.nih.gov/32245590/. [Last acessed on 2020 Jul 22].  Back to cited text no. 34
Yu S, Wang J, Shen H. Network pharmacology-based analysis of the role of traditional Chinese herbal medicines in the treatment of COVID-19. Ann Cardiothorac Surg 2020;9:437-46. Availablefrom: http://apm.amegroups.com/article/view/38241/29299. [Last accessed on 2020 Jul 22].  Back to cited text no. 35


  [Figure 1]

  [Table 1], [Table 2], [Table 3], [Table 4]


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